Changes in Lymphocyte Subsets in Depressed HIV-Infected Patients Without Antiretroviral Therapy

Health-related quality of life of people living with HIV infection in Spain: a gender perspective

Studies exploring gender differences in health-related quality of life (HRQOL) of people living with HIV/AIDS (PLWHA) are scarce and contradictory. This study evaluated gender differences in HRQOL of 744 PLWHA with median (IQR) age 44 (37-48) years and HIV infection diagnosed 12 (5-20) years earlier. Results showed important differences between genders (p < .05). Better male physical health was related to being employed, not having economic worries, not receiving psychological support, not having injected drugs in past, low negative mood HIV-related, low HIV illness representation and internalized stigma, and high body image satisfaction and health behavior. For women, variables were fewer years since HIV diagnosis and low enacted stigma-personal experience of rejection. Mentally, variables in men were being employed, not having injected drugs, having a stable partner, high health behavior, use of problem-solving coping, personal autonomy and personal meaning. In women, better mental health was related to high CD4 cells, self-esteem and body image satisfaction, and negative mood HIV-related. Men and women coincided in absence of past opportunistic infections being related to better physical and mental health, and absence of side effects for physical health and low HIV-related stress and HIV illness representation for mental health. Our results highlight the need for detailed study of gender differences that identify the bio-psycho-socio inequalities that affect HRQOL.

Predictive factors and incidence of anxiety and depression in a cohort of HIV-positive patients in French Guiana

A retrospective cohort study was conducted to determine the predictive factors and the incidence of anxiety and depression in a cohort of patients followed in French Guiana. A total of 2315 patients were followed for a total of 9116 years of follow-up. The incidence rate of first observed depression was 1.89 per 100 person years. The incidence rate of first observed generalized anxiety was 1.27 per 100 person years. A single failure Cox proportional hazards model showed that patients diagnosed <1 year (Hazard ratio (HR)=4.15; 95% CI=1.15-14.9; P=0.029), patients treated <one year (HR=3.2; 95% CI=1.7-6.2; P<0.001), patients with anxiety (HR=37; 95% CI=19-72; P<0.001), females (HR=2.5; 95% CI=1.5-4; P<0.001), French citizens (HR=1.6; 95% CI=1.05-2.5; P=0.029), and patients with severe immunodeficiency (HR=3.7; 95% CI=1.7-7.8; P=0.001) were at increased risk of depression. For anxiety, recently diagnosed patients (HR=11.7; 95% CI=3.2-42; P<0.001) and females (HR=3; 95% CI=1.6-5.8; P=0.001) were at increased risk. The hazard function showed that there were three peaks for anxiety (2, 6, and 11 years) and depression (2, 7, and 14 years). Incidence of anxiety and depression in this HIV cohort is high. Knowledge of this pattern may help physicians be more vigilant to psychological distress at certain phases of life with HIV.

Impact of depression on HIV outcomes in the HAART era

Highly active antiretroviral therapy (HAART) has significantly decreased the morbidity and mortality of persons infected with HIV. The extent of the benefits, however, is not uniform, and certain factors including ethnicity, gender, baseline HIV viral load and CD4+ T lymphocyte count, adherence and intravenous drug abuse are associated with different immunological, virological and clinical outcomes. Mental health illness (MHI) and specifically depression may be associated with worse outcomes, although studies exploring the impact of MHI on HIV outcomes in both the pre-HAART and post-HAART eras have shown mixed results. The objective of the current paper is to review the available literature on the impact of MHI on HIV outcomes in the HAART era.

Major depression-related immunological changes and combination antiretroviral therapy in HIV-seropositive patients

BACKGROUND

In physically healthy subjects, major depression has been associated with several changes in immune function. In HIV-infected subjects too, lymphocyte subsets changes related to psychological conditions have been described.

OBJECTIVE

The aim of this study was to investigate the effect of major depression on immunological parameters in HIV-infected subjects and to examine the influence of different potency antiretroviral therapies on depression-related immunological changes.

METHOD

Thirty-six HIV-infected patients with major depression treated with different potency antiretroviral therapies (none, double, triple) were compared with 77 matched non-depressed HIV controls with regard to demographic, clinical and immunological parameters.

RESULTS

The presence of depression was a significant predictor of natural killer (NK) cell number and percentage decline. Antiretroviral therapy and depression-antiretroviral therapy interaction do not significantly influence depression-related NK cell changes.

CONCLUSIONS

The study confirms the role of depression in influencing the immune response in HIV-seropositive subjects and suggests that antiretroviral therapies may not be able to hamper the depression-related NK cell changes even using the most potent regimens such as Highly Active Antiretroviral Therapy (HAART).

The impact of neuropsychological impairment and depression on health-related quality of life in HIV-infection

Neuropsychological impairment and depression are common among individual with HIV-infection, resulting in significantly altered everyday functioning. The objective of this study was to examine the impact of these two important neurobehavioural complications on health-related quality of life in adults with HIV-infection. Participants (n = 155) received a 3-hours comprehensive neuropsychological examination, the Beck Depression Inventory, and the Medical Outcomes Study HIV Quality of Life instrument. Four groups were formed based on the presence or absence of depression and neuropsychological impairment. Results suggest that neuropsychological impairment and depression can differentially affect dimensions of health-related quality of Life. Specifically, depression has a significant impact on mental health dimensions of health-related quality of life. Some evidence exists for an impact of neuropsychological impairment, or a combined impact of depression and neuropsychological impairment, on the Physical Health dimensions of health-related quality of life. These results confirm the importance of depression as a determinant of health-related quality of life in HIV/AIDS and provide a potential avenue for improving health-related quality of life in adults with HIV-infection.

Zur Bedeutung depressiver Störungen für die somatische Medizin/ The importance of depressive disorders in somatic medicine

Depressive disorders--including mild and subthreshold forms--are frequent in medical patients, although often not recognized. Over the past decades accumulating scientific evidence has demonstrated their clinical relevance. Depressive disorders and also elevated scores on self-rating scales for depressive symptoms are clearly related to disease behavior and quality of life. In many physical conditions they also predict adverse outcome, including premature death. This paper gives an overview of the literature on the relevance and treatment of comorbid depression in patients with HIV infection, cancer and coronary heart disease. It shows that the subjective effects of depression are rather similar in different somatic conditions. In addition, depression also interacts with the physical course of different diseases. However, the specific physiological mediators involved vary among different somatic diseases and have not yet been completely understood. Despite this uncertainty an improved recognition and treatment of comorbid depression can be recommended. Supportive interventions focussing on coping demands as well as regular psychotherapy and in some cases antidepressant medication may be indicated. While it still appears premature to establish generally applicable treatment guidelines, an individualized approach with regard to the different treatment alternatives for individual patients should be advocated.